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Up to the present I have noted only one nerve recurrence after the use of salvarsan, namely, a unilateral optic- neuritis in a physician, previously cited, and am convinced that it was due to a specific process. It occurred Non-prescription Viagra Alternatives si.x weeks after treatment and four months after infection, was an acute one sided inflammation, and was influenced by further anti- syphilitic medication. In Novem.ber, 1910, I treated a patient in whom an acute optic neuritis liad de- veloped after nine months' treatment with bichlor- ide injections, with salvarsan. 0.6 gramme alkaline solution. In this case Non-prescription Viagra Alternatives a cure resulted, the last oph- thalmological report by Dr. Holzapfel, a few days ago. reading: Vision 20/30, Non-prescription Viagra Alternatives haemorrhages com- pletely absorbed, fundus normal in every respect. I have also treated several cases of chorioiditis with acute optic neuritis coming on in the early stage of the disease with very decided benefit. It seems Non-prescription Viagra Alternatives to me that a sharp distinction should be drawn between those cases of acute optic neuritis of imdoubted specific . origin and the primary de- generative forms. We have here an analogy with the two types of tabes previously described, in one of whicii we have inflammatory symptoms and in the other a pure degeneration. In these degenera- tive forms of the optic nerve and the posterior col- umns of the cord it seems to me we do harm to our patients by giving this drug or intensive mercurial treatment which is so often employed, both of these therapeutic measures hastening the process. In a case of interstitial keratitis involving one eye, of four weeks' duration, in a child eight years old, I admin- istered, on March 15th, 0.2 gramme Non-prescription Viagra Alternatives oil suspension, on March 25lh 0.3 gramme alkaline solution. This patient was kindly referred to me by Dr. Colman W. Cutler, who said that a result had Non-prescription Viagra Alternatives been obtained in a few weeks which could not have been hoped for under six months with the ordinary drugs ; all of the ciliary congestion disappeared afid the corneal opacity was clearing. On April 7th, how- ever, a similar condition developed in Non-prescription Viagra Alternatives the Non-prescription Viagra Alternatives other eye but of a much less degree ; this was controlled by a third in- jection of 0.2 gramme oil suspension. As an illustration of the fallacy of the post hoc propter hoc method of reasoning and the tendency to attribute all of these nerve recurrences to sal- varsan, the following cases are cited, one of which developed after the administration of salvarsan and cleared up after a second dose, the other two oc- curring in patients in the early stage of syphilis, in the one treated with mercury and the other un- treated. 1. A physician whom I treated on November 23d for an infection acquired in September, 1910, was attacked about February i, 191 1, with impairment of hearing in the right ear, accompanied by a blowing sound and pain along the trifacial nerve, both very severe at times and worse at night. Believing he was suffering from a Non-prescription Viagra Alternatives recurrence he began a course of inunctions, but without Non-prescription Viagra Alternatives much effect. A rhinologist whom he consulted diagnosticated the con- dition as a sinusitis and advised the use of an adrenalin spray. He obtained relief from the latter but also took another injection of salvarsan, and the improvement which had set in at the time of administration continued until now he is entirely free from symptoms referable to his trouble. 2. I have at present another physician under my care, in whom in the fifth month of his infection labyrinthine disease developed, with headache, deafness, vertigo, and a tendency to fall to the right — this recurrence after Non-prescription Viagra Alternatives mer- curial and enesol treatment. Under more active mercurial medication and large doses of potassium iodide his symp- toms disappeared and his hearing improved. 3. The third case has just come into my service during the past week. The patient gives no history of initial lesion, but in January of this year an eruption developed which has persisted to the present time, and consists of a grouped follicular syphilide. He also has a severe pharyn- gitis. About the middle of March headache, tinnitus, and dizziness developed, and when he entered the hospital, .April loth, he presented marked symptoms pointing to in- volvement of the labyrinth. According to West, five per cent, of the indi- viduals infected with syphilis suffer from laby- rinthine disease between the fifth and twelfth months. Politzer quotes a much higher proportion, namely, from seven to forty-eight per cent. Non-prescription Viagra Alternatives Of sixty-five cases of auditory nerve involvement col- lected by Meyer, it was found that twenty per cent, occurred from the third to the tenth week after ap- ])earance of the primary lesion. In my opinion the intramuscular injection of the alkaline solution brings about as quick a resolution of the lesions as the intravenous method ; probably in the later stage of the disease it is more effica- cious than the latter, but the intense pain produced by it makes one hesitate Non-prescription Viagra Alternatives about recommending it. It would seem to Non-prescription Viagra Alternatives be better to give two, three, or even more intravenous injections than to subject the patient to Non-prescription Viagra Alternatives the pain and jjossible danger of arsenic necrosis from Non-prescription Viagra Alternatives intramuscular use of the drug. In the past six weeks I have been following the intravenous injection one week later by an intra- muscular one of Non-prescription Viagra Alternatives an oil suspension. The latter method is freer from pain than the alkaline solu- tion, but I have not yet been able to determine whether it is as efficacious, as it will require a con- siderably longer period of observation. In a per- sonal communication recently received. Professor Ehrlich rather discredits the employment of an oil suspension and gives his preference to the intra- venous use of the drug in all stages of the disease, emphasizing the necessity of repeating the injection and combining it with mercury. In the great majority of cases patients are caused no inconvenience by the intravenous method of 866 FORDVCE: SALVARSAN. administration. In a few I have noted a marked reaction within from two to six hours after the injection. This consisted in a chill or chilly sensa- tions, sometimes followed by a rise of temperature,